Individual
BRADLEY T BUTKOVICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6160 KEMPSVILLE CIR, SUITE 200B, NORFOLK, VA 23502-3933
(757) 321-3383
(757) 321-3332
Mailing address
230 CLEARFIELD AVE, SUITE 124, VIRGINIA BEACH, VA 23462-1832
(757) 321-3383
(757) 321-3332
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
0101237415
VA
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
0101237415
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1154372712
—
VA
01
—
C05501
MEDICARE GROUP PIN
VA
Enumeration date
05/16/2006
Last updated
02/08/2021
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